The present invention relates in general to fracture bracing and in particular to an improved fracture brace of the type that permits ambulation of a patient with a fractured tibia.
Traditionally, fractures of the tibia have been treated with a toe-to-groin cast of plaster of paris. The cast immobilized the ankle, leg, knee and thigh. The immobilization of the leg severely limits the mobility of the typical patient. A plaster cast is uncomfortable because of its weight and inability to relieve itching. Lack of ambulation can lead to joint stiffening and muscle atrophy.
Within the past few years it has been recognized that a special type of fracture brace or orthosis for tibia and fibula fractures can be used in place of toe-to-groin casts with efficacy after an initial period with the toe-to-groin cast. This fracture brace extends from the foot to the knee. It completely encases the involved leg in a rigid case. Loads from ambulation are transferred to the proximal part of the skeleton by the case, cased musculature, and the involved tibia and fibula. It has been found that this loading can enhance osteogenesis. Any shortening of the involved leg with this technique is of the same magnitude as with plaster casts. Any rotation and angulation of the involved bone is also of the same magnitude. The fracture orthosis permits proximal joint use and reduces atrophy. Incidence of non-union of the bones is less.
The acuteness of the initial injury usually results in appreciable swelling, discomfort, and soft tissue damage for which a toe-to-groin cast is necessary. A foot-to-knee fracture brace can be used after initial acute treatment in a toe-to-groin cast, or after soft tissue damage has healed. A use of the fracture brace with soft tissue damage can result in unacceptable discomfort because of pressure on the damaged tissue.
The foot-to-knee fracture brace has used footplates coupled to the brace with flexion joints to permit limited mobility of the ankle.
Some difficulties have been experienced in coupling the footplate to the fracture brace to accommodate required foot position with respect to the leg. Considerable constraint is required to avoid unacceptable angulation and rotation of an involved tibia and fibula. The proper position of the foot with respect to the leg is an absolute must to avoid trouble in these areas. The anatomies of different people compound the difficulty in designing suitable couplings between the footplate and the fracture brace.
Casts require removal to treat soft tissue damage, or to make adjustments necessary for the encapsulation required for the proper fit between the bone, cast, and soft tissue. Plaster-of-paris casts once removed cannot be reused, and are not adjustable. Orthoses using Orthoplast (a trademark of Johnson and Johnson) can be removed, adjusted, and reused, but with some difficulty.
Orthoses made of plastic have been employed in the past, but problems have been encountered in sizing such orthoses to accommodate the infinite sizes and shapes of the patients while at the same time providing effective encapsulation. Plastic, also, is hard and can irritate bony areas such as the bony prominences of the medial and lateral malleolus.